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NEBH Care Guidelines for Patients with Metal-on-Metal Hip Implants

Recently there have been concerning reports about rare but serious side effects of metal-on-metal hip implants. This issue is of particular concern at the Baptist, since we perform more joint replacement surgeries than any other hospital in New England and our commitment to patient safety is paramount.

Large studies and our own experience as a national orthopedic center of excellence indicate that metal implants perform well in the vast majority of patients. Still, some patients have experienced adverse reactions to metal wear debris from metal implants, or from metal ions released by the implants.

One implant model, the DePuy ASR ™ Hip System, was voluntarily recalled in 2010. This implant was used in a small fraction of the hip replacements performed in the United States before 2009. At New England Baptist, it was used in 0.5% of the cases we performed between 2006 and 2009. All Baptist patients who received the implant were notified of the recall more than 18 months ago.

Definitive clinical evidence on metal-on-metal hip implants is still being collected. New research suggests these problems may be associated with implants that include a large (greater than 38 mm) femoral head - used to provide stability and improved motion.

Until more information is available, we have suspended the use of metal-on-metal implants except in a few selected cases where clinical criteria indicate it is the best alternative.

We believe it is important for all metal-on-metal hip implant patients to receive thorough follow-up care. We have developed these guidelines for care of patients with metal-on-metal hip implants:

Patients with metal-on-metal implants should follow the recommendations of their surgeons for monitoring - usually a history, physical exam, and routine x-rays. Testing for serum cobalt and chrome levels or MRI scanning of the hip also may be indicated for symptomatic patients.

Symptomatic Patients

  • If new symptoms or significantly worsening problems develop with the hip, including pain, swelling, numbness, or a limp or change in ability to walk, the patient should contact the surgeon immediately. It also is important to note changes in general health and any new conditions that have arisen since the hip replacement.
  • New symptoms or medical conditions other than at the hip should be reported to the primary care physician for assessment, with a reminder that the patient has a metal-on-metal hip implant.

Symptom-Free Patients

  • If the patient is not experiencing any symptoms and the surgeon believes the metal-on-metal hip implant is functioning appropriately, there are no data to support the need for additional tests.
  • Patients should continue to follow up with their orthopedic surgeons for periodic examinations. We recommend that patients without symptoms see their surgeons at one year, two years, and five years following surgery and then every two to three years, or as determined by the surgeon.

Patients Who Have a Recalled Implant

The DePuy ASR ™ Hip System was recalled in 2010. If a patient has one of these implants it does not necessarily need to be removed and replaced. In most cases, the recall simply means different or more frequent monitoring is warranted. It is important for patients to discuss the reason for the recall with their surgeons to determine the most appropriate course of action.

Additional Information Regarding Metal-on-Metal Hip Systems

More information is available on the following sites:

US Food and Drug Administration

American Academy of Orthopaedic Surgeons

American Association of Hip and Knee Surgeons

For a Second Opinion

Surgeons at New England Baptist regularly evaluate patients who have received hip implants (metal-on-metal and other types) at other hospitals. To make an appointment with one of our specialists, contact our physician referral line at 1-800-370-6325.

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